Healthcare Provider Details

I. General information

NPI: 1437497609
Provider Name (Legal Business Name): LIZ XIANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E COLORADO BLVD
PASADENA CA
91101-2104
US

IV. Provider business mailing address

PO BOX 5204
CERRITOS CA
90703-5204
US

V. Phone/Fax

Practice location:
  • Phone: 562-405-2566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number64464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: